St. Luke’s adopts new antibiotic policy

Raising the standards in quality healthcare in the country, St. Luke’s Medical Center began implementing a new antibiotic policy last Aug. 1.

The new policy provides guidelines aimed at assisting physicians in choosing the most rational, safe, effective and cost-efficient antimicrobial to promote its judicious use and to minimize antibiotic resistance.

Dr. Celia Carlos, chairwoman of St. Luke’s Subcommittee on Criteria-monitored Drugs of the Pharmacy and Therapeutics Committee, said the Criteria-Monitored Antimicrobials (CMA) policy is meant to address antimicrobial resistance, one of the key issues in the management of infectious diseases worldwide.

"Based on evidence gathered from scientific literature, expert opinion and from existing treatment guidelines, the committee came up with a list of antibiotics with pre-determined criteria for use," she said.

"With this policy, we hope the doctors at St. Luke‘s will be able to more appropriately prescribe the identified CMAs using established indications," she added.

The management of St. Luke’s created the subcommittee on criteria-monitored drugs for antibiotics in August 2003 with the task of devising an improved antibiotic policy for St. Luke’s on the basis of scientific evidence by formulating criteria for the use of selected antibiotics.

It is composed of a chairwoman and 16 members from infectious disease, ear nose and throat, ophthalmology, obstetrics-gynecology, medical intensive care unit, surgery, emergency medicine, microbiology, epidemiology, pharmacology, nursing service, pharmacy and infection control service.

The policy is also a requirement of the Joint Commission International (JCI) under its quality management and improvement policies.

St. Luke’s is the only medical institution in the Philippines that has passed the exacting standards of the world’s most prestigious healthcare accrediting organization.

The hospital was awarded JCI accreditation in November 2003, the second of only five hospitals in Asia to be accorded the highly covered accreditation.

"Antibiotic policies have long been implemented in developed nations, and developing countries are beginning to do the same," Carlos said.

"The list of CMAs that the committee has developed include 17 antimicrobials and these are amikacini sulfate, ertapenem, imipenem + cilastatin sodium, meropenem, ceftazidime, cefepime hydrochloride, vancomycin, ztreonam, linezolid, piperacillin + tazobactam, ticarcillin clavulanate, gatifloxacin, moxifloxacin, levofloxacin, amphotericin B, fluconazole, and itraconazole."

Carlos added that narrowing the choice of CMAs to 17 would be better for patients in the long run so that they will not develop significant levels of resistance to these antimicrobials.

Physicians will be encouraged to prescribe first-line antimicrobials to patients first. If these fail to relieve the patient of his symptoms, second-line antimicrobials, which are more potent, will then be administered.

The list of CMAs and their specific accepted criteria for use are being circulated among the physicians of St. Luke’s and provided in all nurse stations in print and, in the future, via the online Formulary of the hospital.

The CMA policy is being initially implemented in four pilot units – the Nursery, Cancer Unit I and 2, and the Medical Intensive Care Unit. These units were chosen because their patients are at high risk from infections.

"If the policy works in these four units, then it can be applied to the entire hospital," Carlos said.